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General NPI Number Information
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NPI Number | 1922274844
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Entity Type | Organization
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Legal Business Name | OPTUM PALLIATIVE AND HOSPICE CARE, INC.
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 7755 PARAGON ROAD SUITE 106
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City | DAYTON
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State | OH
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Zip | 45459-4052
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Country | US
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Telephone | 937-226-8611
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Fax | 888-810-8182
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Provider Business Mailing Address
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Address Line | PO BOX 15645
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City | LAS VEGAS
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State | NV
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Zip | 89114-5645
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Country | US
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Telephone | 215-902-8241
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Fax | 215-902-8809
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | JOHN O. ENDERLE
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Credential |
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Telephone | 860-221-0793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 0158HSP
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License Number State | OH
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